A 30-year-old woman with Crohn's disease involving the terminal ileum has developed two symptomatic strictures, each < 4 cm long, 20 cm apart. She is otherwise well. The preferred surgical approach to preserve maximal intestinal length is:
- A Strictureplasty (Heineke-Mikulicz for short strictures) ✓
- B Extended right hemicolectomy including both strictures
- C Balloon dilatation for both strictures
- D Total parenteral nutrition and immunosuppression alone
Correct answer: A. Strictureplasty (Heineke-Mikulicz for short strictures)
Explanation
Strictureplasty is the preferred technique for short (< 10 cm) fibrotic strictures in Crohn's disease, particularly when resection would jeopardise intestinal length. The Heineke-Mikulicz technique (longitudinal incision closed transversely) is used for strictures ≤ 10 cm. The Finney (side-to-side) or Michelassi (isoperistaltic side-to-side) techniques are used for longer strictures. Strictureplasty has comparable recurrence rates to resection and preserves gut length, critical in patients with previous resections.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.